Phyiscal Therapy Direct Access

As a physical therapist, a major part of my job is patient education. Whether it's instructing someone in exercise, a self-care technique, or proper body mechanics, my objective is to empower a patient towards wellness.

Part of patient education is spreading the word about the latest research, evidence, and best practice. It's also about teaching people about how best to navigate the perpetually complex world of health care. Sometimes, folks don't know where their point of entry should be when they get hurt or begin to experience pain "out of the blue." Recently, I've spoken with several people who were surprised to learn that they did not necessarily need a prescription to initiate physical therapy care.

On November 23, 2006, physical therapy became a direct access discipline in New York State, following a nationwide trend. What that means is that you may walk into any practitioner's office (who has at least 3 years of experience) for an evaluation. You may be seen for up to 10 visits or 30 days (whichever comes first), before requiring a prescription from a physician, podiatrist, dentist, or nurse practitioner. A physical therapist possesses the knowledge and skills necessary to recognize from a first visit if a patient needs to be referred on to one of the above prior to initiating care. But the reality is, many musculoskeletal issues do NOT require a screen from a doctor prior to beginning physical therapy. Usually, the doctor will simply write a prescription for PT with the instruction to return in 6 weeks for potential imaging should the more conservative approach of therapy not produce adequate results.

Now, I am not suggesting that should you experience a trauma, you should skip the ER an head right to a physical therapist's office. Usually the first step in those cases is an x-ray to rule out a fracture. But barring a trauma, one should consider contacting a local physical therapist first. He or she will conduct a thorough subjective and objective exam that will help narrow down the issue. They will also be able to provide a plan of care to address it. This may save you an office visit elsewhere.

I never get in the way of a patient's instinct to go to see a doctor for something they are concerned about. By all means, if that is your gut feeling, go for it. I am simply sharing this information to let you know what the law is and how the system works. Knowledge is power.


While direct access states allow for people to initiate physical therapy care as a first step, you should always check with your insurance company to see if theby require a prescription for care.